{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T02:22:48Z","timestamp":1783477368250,"version":"3.55.0"},"reference-count":27,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2021,2,15]],"date-time":"2021-02-15T00:00:00Z","timestamp":1613347200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Endocrinology"],"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective and background<\/jats:title><jats:p>Secondary adrenal insufficiency (SAI) is a rare condition in childhood which can be associated with high levels of morbidity in some patients. The causes of increased levels of illness are not well defined and warrant further investigation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective cohort of patients with SAI was constructed by examining records of all attendances for acute illness by SAI patients at the emergency department of the two specialist paediatric hospitals in Sydney, Australia between 2004 and 2016. Demographic, clinical, and physiological characteristics together with pre\u2010hospital illness management strategies were assessed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were 168 presentations for an acute illness by 47 children with SAI. Comorbid diabetes insipidus (DI) was present in 46.8% (n\u00a0=\u00a022), 77.3% (n\u00a0=\u00a017) of whom were male (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.05). Patients with comorbid DI were more likely to be admitted (86.7%, n\u00a0=\u00a065 vs 60.2%, n\u00a0=\u00a056 for non\u2010DI, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.01); had a longer hospital stay (6.5 (8.7) vs 2.5 (2.6) days, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.001); and higher rates of IV HC administration (56.0%, n\u00a0=\u00a042 vs 35.5%, n\u00a0=\u00a033), <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.01). The medically\u2010diagnosed adrenal crisis (AC) rate was 3.68 ACs\/100PY. Stress dose use was reported by fewer DI patients (58.7%, n\u00a0=\u00a044) than non\u2010DI patients (78.5%, n\u00a0=\u00a073, <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a0.01). Previous attendance at hospital was positively associated with stress dose use (OR\u00a0=\u00a01.08, 95% CI 1.00, 1.16).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Secondary adrenal insufficiency can cause significant morbidity in children. Comorbid DI is associated with higher levels of hospitalisation, longer hospital stays and lower levels of pre\u2010emergent stress dose use. Educational interventions in this subgroup of SAI patients may reduce the burden of morbidity.<\/jats:p><\/jats:sec>","DOI":"10.1111\/cen.14427","type":"journal-article","created":{"date-parts":[[2021,2,6]],"date-time":"2021-02-06T09:43:22Z","timestamp":1612604602000},"page":"913-919","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Acute illness in children with secondary adrenal insufficiency"],"prefix":"10.1111","volume":"94","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6270-747X","authenticated-orcid":false,"given":"Rosemary Louise","family":"Rushworth","sequence":"first","affiliation":[{"name":"School of Medicine, Sydney The University of Notre Dame Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikki","family":"Gouvoussis","sequence":"additional","affiliation":[{"name":"School of Medicine, Sydney The University of Notre Dame Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5873-1610","authenticated-orcid":false,"given":"Thomas","family":"Goubar","sequence":"additional","affiliation":[{"name":"School of Medicine, Sydney The University of Notre Dame Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann","family":"Maguire","sequence":"additional","affiliation":[{"name":"Institute of Endocrinology and Diabetes The Children\u2019s Hospital at Westmead Westmead Australia"},{"name":"Faculty of Medicine and Health, Children\u2019s Hospital Westmead Clinical School University of Sydney Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Craig F.","family":"Munns","sequence":"additional","affiliation":[{"name":"Institute of Endocrinology and Diabetes The Children\u2019s Hospital at Westmead Westmead Australia"},{"name":"Faculty of Medicine and Health, Children\u2019s Hospital Westmead Clinical School University of Sydney Sydney Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristen A.","family":"Neville","sequence":"additional","affiliation":[{"name":"Department of Endocrinology Sydney Children\u2019s Hospital Randwick NSW Australia"},{"name":"School of Women and Children\u2019s Health Faculty of Medicine UNSW Sydney NSW Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J.","family":"Torpy","sequence":"additional","affiliation":[{"name":"Endocrine and Metabolic Unit Royal Adelaide Hospital and University of Adelaide Adelaide SA Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,2,15]]},"reference":[{"issue":"10","key":"e_1_2_8_2_1","first-page":"1544","article-title":"The etiologies of adrenal insufficiency in 73 Thai children: 20 years experience","volume":"91","author":"Osuwannaratana P","year":"2008","journal-title":"J Med Assoc Thai"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild-2015-308799"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1159\/000481660"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1515\/jpem-2019-0030"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1155\/2018\/1739831"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2018-01175"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1807486"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12020-016-1204-2"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-14-0824"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.beem.2015.04.002"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2010.08.021"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/cen.13826"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-12-0161"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2014-3191"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1159\/000479370"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychores.2013.07.009"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11102-008-0105-7"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00018-015-1930-2"},{"key":"e_1_2_8_20_1","volume-title":"International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Australian Modification (ICD\u201010\u2010AM), Australian Classification of Health Interventions (ACHI), Australian Coding Standards (ACS)","author":"National Centre for Classification in Health","year":"2006"},{"key":"e_1_2_8_21_1","unstructured":"Sydney Local Health District.Common Tests Listing.https:\/\/www.slhd.nsw.gov.au\/SSWPS\/handbook\/Essential.asp?type=Common. 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